Comparison of lodixanol and loversol for the Prevention of Contrast-Induced Nephropathy in Diabetic Patients After Coronary Angiography or Angioplasty

Introduction and objectives. This study was designed to compare differences in the incidence of contrast-induced nephropathy (CIN) and changes in serum creatinine (SCr) level following iso-osmolar iodixanol or low-osmolar ioversol administration in diabetic patients undergoing coronary angiography, with or without percutaneous coronary intervention (PCI). A number of studies have indicated that iodixanol reduces the risk of CIN in patients with renal impairment, with or without diabetes. Diabetic patients may have some degree of renal dysfunction despite having a normal SCr level. Methods. The study included 250 consecutive diabetic patients undergoing coronary angiography with or without PCI. Those enrolled during the first 7 months of the study received ioversol and those enrolled during the following 11 months received iodixanol. The primary study endpoint was the incidence of CIN. Secondary objectives were to identify independent predictors of CIN and to determine the mean increase in SCr 72 hours after contrast injection. Results. The overall incidence of CIN was 5.6%. The incidence of CIN was significantly lower with iodixanol than with ioversol (2.5% vs. 8.3%, respectively; odds ratio [OR]=0.255; 95% confidence interval [CI], 0.068-0.952; P=.047). A low estimated glomerular filtration rate (60.8+/-29 mL/min per 1.73 m(2) in those with CIN vs. 75.3+/-25 mL/min per 1.73 m(2) in those without; OR=0.975; 95% Cl, 0.952-0.997; P=.03) and ioversol use were independent predictors of CIN. Conclusions. In diabetic patients undergoing diagnostic coronary angiography with or without PCI, the iso-osmolar contrast medium iodixanol was associated with a lower incidence of CIN than low-osmolar ioversol.